What is MR Guided Focused Ultrasound (MRgFUS) and what is its role in the management of fibroids?

Objective

To estimate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids, which starts with Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) as compared with current practice comprising uterine artery embolisation, myomectomy and hysterectomy.

Design:

Cost-utility analysis based on a Markov model.

Setting:

National Health Service (NHS) Trusts in England and Wales.

Population:

Women for whom surgical treatment for uterine fibroids is being considered.

Methods:

The parameters of the Markov model of the treatment of uterine fibroids are drawn from a series of clinical studies of MRgFUS, and from the clinical effectiveness literature. Health-related quality of life is measured using the 6D. Costs are estimated from the perspective of the NHS. The impact of uncertainty is examined using deterministic and probabilistic sensitivity analysis.

Main Outcome Measures:

Incremental cost-effectiveness measured by cost per quality-adjusted life-year (QALY) gained.

Results:

The base-case results imply a cost saving and a small QALY gain per woman as a result of an MRgFUS treatment strategy. The cost per QALY gained is sensitive to cost of MRgFUS relative to other treatments, the age of the woman and the nonperfused volume relative to the total fibroids volume.

Conclusions:

A treatment strategy for symptomatic uterine fibroids starting with MRgFUS is likely to be cost-effective.